Fantastic opportunity with SSM to take your career to the next level. Must have CPC Certification or AHIMA Certification. This role has the ability to be remote within the SSM network which includes St. Louis, Wisconsin, Oklahoma, or Illinois.
Oversees staff education, quality improvement, policy development, and monitoring of compliance risk related but not limited to billing, coding, and medical record documentation. Ensures that commitment to the compliance program is communicated and ensures the program's effectiveness. Facilitates meeting appropriate regulatory standards related to billing, reimbursement and third-party contractual arrangements. Ensures that employees (including physicians) comply with policies, third party requirements and federal regulations. Provides leadership in process improvement and collaborative strategies with others as well as creative approaches to complex situations. Oversees and monitors the organizations' corporate responsibility programs for assigned regulatory and operational functions. Assists leadership with planning, developing, implementing and coordinating systems to detect, correct and prevent potential problems of noncompliance within the applicable operating units. Ensures that commitment to programs are communicated and adhered to throughout the assigned operational units.
Job Responsibilities and Requirements:
Assists leadership in the oversight and implementation of the corporate responsibility process (CRP) for assigned regulatory and operational functions, including compliance awareness education, implementation and maintenance of compliance policies and procedures, and monitoring of policy adherence and enforcement.
Supervises staff and related processes to ensure implementation, monitoring and enforcement of compliance and regulatory guidance.
Responsible for the supervision of staff in the performance of audits and investigations of high risk compliance issues, including but not limited to billing, coding, and governmental audit issues or findings.
Prepares and delivers reports and updates to CRP, front line, and senior leaders outlining areas of concern and/noncompliance.
Serves as a resource to assigned regulatory and operational functions in establishing methods to improve regulatory and legal compliance and reduce vulnerability to fraud, abuse, and waste.
Collaborates to periodically revise system policies and processes in light of changes in laws and regulations stemming from government and private payer plans.
Remains current with government and third party billing regulations, government initiatives on fraud and abuse, and other related legislation.
Serves as a resource to all internal and external customers, answering questions, researching topics and providing information regarding coding, documentation and compliance issues.
Partners with other individuals/departments to foster best practice methodology and compliance.
Performs other duties as assigned.
Bachelor's degree or equivalent combination of experience and education
Minimum five years' experience, with at least two years supervising a team
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
81340033 Corp Responsibility
Day Shift (United States of America)
Scheduled Weekly Hours:
SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.